Bioethics最新文献

Medical predictions, for example, concerning a patient's likelihood of survival, can be used to efficiently allocate scarce resources. Predictions of patient behaviour can also be used—for example, patients on the liver transplant waiting list could receive lower priority based on a high likelihood of non-adherence to their immunosuppressant medication regimen or of drinking excessively. But is this ethically acceptable? In this paper, we will explore arguments for and against behavioural predictions, before providing novel empirical evidence on this question. Firstly, we note that including behavioural predictions would lead to improved transplant outcomes. Fairness could also require prioritising those predicted to engage in healthier behaviours: consistent with using behavioural predictions in other contexts such as psychiatry and substance misuse. Conversely, behavioural predictions may be judged too inaccurate or discriminatory, or it may be thought unfair to deprioritise based on future behaviour. In part two, we performed an online survey of 172 UK adults. When presented with possible factors relevant to liver allocation, most thought predictions of higher medication adherence (78.6%) and lower future alcohol use (76.5%) should be used but not predictions of lower future criminality (24.7%) and higher societal contribution (21.2%). Randomising participants into two groups, 69.8% of participants found deprioritising a patient based on their predicted medication adherence acceptable (91.9% found a nonbehavioural prediction acceptable). We did not identify an ethically relevant difference between behavioural predictions and other medical predictions already used in organ allocation. Our sample of participants also appeared to support behavioural predictions in this context.

Although we have a long-standing and well-institutionalized practice of medical aid in dying (MAID) in the Netherlands, it is insufficiently clarified which goals ethicists should pursue in the context of assisted dying, and which competencies they need to fulfil their role(s). We sought to contribute to this clarification. We argue that both in anticipation and in evaluation of MAID, ethicists fulfil a role that is highly valuable to good MAID practice, and complementary to that of other professionals. Whereas the involvement of the ethicist preceding MAID, for instance, to provide ethics support in the case of complex decision-making, is elective in the Netherlands, the participation of ethicists in evaluating performed MAID cases is obligatory, as they are required members of the interdisciplinary regional review committees that judge every case of MAID. We discuss some misconceptions and less-than-optimal performances of both these roles of the ethicist, then focus on how these roles should be perceived, and which kinds of ethics expertise are necessary for ethicists to make a valuable contribution to good MAID practice.

I shall initially be discussing the term ‘disability’ in accordance with common-sense intuition. The term itself is contested. But importantly for our discussion, on the mere-difference view, Barnes attempts to philosophically define disability in conformity with what we ordinarily perceive to be disability day to day, and she does so by appealing to the rules of solidarity employed by the disability rights movement as definitive of those conditions that the movement should promote justice for and thus of who counts as disabled. I will operate on the assumption that this is correct during much of the essay, so as to assess whether Barnes' mere-difference view is vulnerable to an argument from pain. I suggest that Barnes could follow three lines of argument in order to try to circumvent these difficulties, but that each of these faces further problems. I argue that for certain disabilities, in specific cases, the mere-difference view cannot apply, particularly because pain is not necessarily sufficiently balanced by positives. Consequently, I discuss the nuances of when a mere-difference view may be helpful, as opposed to when it might be misguided in its application, and conclude that speaking of disability as a whole as mere-difference or otherwise is misguided, unless we are to reshape the concept of disability into something less heterogeneous.

Human genetic engineering has the potential to profoundly alter the traits of future generations, raising critical ethical questions about authenticity and identity. Essentialist perspectives reject genetic engineering, claiming it inherently compromises authenticity by deviating from a species-typical genome. In contrast, this article advocates for an existentialist interpretation of authenticity, drawing on the philosophies of Heidegger and Sartre. Here, authenticity is understood as a dynamic and relational process rooted in individual choice, responsibility, and engagement with existential conditions. Unlike essentialism, existentialism evaluates genetic interventions not as inherently wrong but based on their alignment with values such as autonomy and authenticity, offering a more flexible and ethically robust framework. Existentialism's emphasis on individual freedom, self-determination, and the creation of meaning in life makes it ethically more compelling than essentialist frameworks, which impose deterministic constraints. Moreover, essentialist critiques falter when they concede the permissibility of therapeutic genetic engineering, undermining the notion of an inherently valuable species-typical human genome. In contrast, existentialism affirms the transformative potential of genetic engineering, recognising it as a means to expand autonomy, self-expression, and opportunities for flourishing when applied responsibly. The article advocates for a balanced ethical approach by integrating the Principle of Procreative Beneficence, which promotes enhancements to optimise flourishing, with the Principle of Procreative Non-Maleficence, which safeguards autonomy by preventing deterministic constraints. This complementary framework, grounded in an existentialist perspective, reframes authenticity as an evolving concept aligned with the transformative possibilities of genetic engineering, enriching the discourse on bioethics and identity in a rapidly changing era.

Critics of human genetic engineering warn that if ever put into practice, this will diminish human diversity, especially regarding skin color. Nonetheless, given the solid and shameful causal link between skin color and discrimination, the provocative question is whether to manipulate this feature and create children whose stereotype-aligning features reduce the risk of evoking hostility in the social environment. To address this possibility, we analyzed data from an interactive exhibit in a German museum that partly addresses these questions. Visitors could manipulate randomized features of a virtual child—for example, appearance and intelligence—to align them with their notion of a “perfect child.” Analysis of N = 13,641 virtual children showed an apparent effect on aligning skin color with a Caucasian type. This was true for extreme light and dark, randomly assigned initial skin colors, but stronger for the latter. This preference could reflect the attempt to align the hypothetical child's skin color with the creating visitors. We also analyzed the chosen skin-color-dependent distribution of designed intelligence based on previous findings showing that high intelligence is less desirable for Black than White persons. We revealed that virtual children with a chosen darker skin color were designed with relatively lower intelligence and a larger proportion of maximized and minimized values. Although most effects were small, they might indicate racial prejudices and/or the attempt to design virtual children with high alignment with normative stereotypes. Our findings provide an important starting point to empirically inform the critical and timely debate about human genetic engineering.

This paper aims to rethink healthcare sustainability from an eco-ethical approach, mainly referring to van Rensselaer Potter's global bioethics and Arne Naess's ecosophy. In this sense, it seeks to address the ethical problem of allocating resources from a non-individualist and essentially bio-medical perspective, which interprets health (or disease) as a mere feature of the individual. On the contrary, starting from a planetary health approach (Potter) and an “ecosophical” view of human beings (Næss), individual health gains meaning in a broader context. At the ethical level, this implies: 1. a focus on the patient's wellbeing, more than his/her diagnosis and cure; 2. a conception of shared responsibility and agency of all stakeholders; 3. the pursuit of ecologically sound decisions that go beyond the individual; 4. promoting environmental stewardship, which may overcome the dichotomy between anthropocentrism and biocentrism; and 5. pursuing epistemic humility. All these pragmatic considerations may inspire the construction of environmentally sustainable health systems. In this regard, the paradigm proposed in this paper is principally directed to healthcare organizations, and not to the particular doctor-patient relationship, where the classical principles of bio-medical ethics might still be appropriate. This non-exclusionary approach allows the integration of the two facets of bioethics: Georgetown bio-medical ethics (Kennedy Institute) and Wisconsin global bioethics (Potter).

Recent calls to include religious bioethics on the table in policy and other public-facing contexts have been made on the grounds of respect. This paper argues that these same considerations of respect point to an obligation to exclude religious bioethics from public-facing contexts. This is because public-facing religious bioethics is typically bio-restrictionist in orientation and thus involves making demands on others that people could reasonably disagree with. At the same time, respect for persons grounds a public justification requirement according to which it is wrong to make moral demands on others that are subject to reasonable disagreement. Proponents of inclusion of these views are thereby committed to excluding such religious bio-restrictionist views from public-facing contexts.

International Humanitarian Law (IHL), specifically Article 18 of the IV Geneva Convention, affords special protection to civilian hospitals. This special protection is waived, however, under certain circumstances specified in Article 19. Such conditions to waive the special protection of hospitals are now being used by Israel to justify the attack on civilian hospitals and healthcare institutions in Gaza. This paper critically evaluates Article 19 and the conditions for the removal of the immunity of hospitals in general and in the specific case of Gaza. The substance and language of Article 19 are found to be flawed in this case. The paper thus argues that Article 19 should be revised to better reflect the special protection hospitals generally and in Gaza specifically should have. This paper is primarily geared at fellow bioethicists who wish to contribute to and lament the injustices occurring in Gaza and elsewhere but are unsure as to how ethical arguments may do so. This paper also addresses international law scholars, inviting further commentary on a novel and ambitious ethical argument to revise long-standing international law. Additionally, the paper is a call to the wider, global public and healthcare providers to actively condemn unjust attacks on healthcare in Gaza and elsewhere in the world. Lastly, the paper is written in a meager attempt at standing in solidarity with the People in Gaza and elsewhere whose healthcare systems are being targeted by unjust governments.